| NPI | 1245339050 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY R055770-01) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NY R055770-1) |
| Enumeration Date | 2006-09-21 |
| Last Update Date | 2023-01-16 |